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High Dose IMRT and Surgery Called ‘Innovative and Promising’ for Mesothelioma


Researchers evaluating a new treatment approach for mesothelioma combining high dose radiation and surgery say the method is promising but challenging.

Under this protocol, pleural mesothelioma patients receive a total of 25Gy (delivered via IMRT) to the lung pleura over five days. (IMRT is a method for delivering radiation to a highly a targeted area.) The radiation treatment is followed by pleurectomy/decortication surgery to remove the diseased pleura and other at-risk tissues.

Drs. Susan Richardson and Vivek Mehta of the Swedish Cancer Institute in Seattle, Washington have treated five mesothelioma patients with this hypo-fractionated IMRT and surgery method with good results. Because the treatment represents a new approach, doctors have no historical treatment data to fall back on. The Swedish Cancer Institute’s findings and their methods for gathering quality data are the subjects of a new report in Medical Physics.

“Due to the compressed schedule, high dose, and shortened planning time, the delivery of the planned doses were monitored for safety with quality metric software,” the authors write. “Early clinical results suggest that this approach is very promising, but also logistically challenging due to the multidisciplinary involvement.”

According to their report, all of the mesothelioma patients treated in this way at the Swedish Cancer Institute tolerated the treatment well and had successful surgeries. No one had any serious side effects, although three people suffered from moderate fatigue, one was mildly nauseous, and one developed mild inflammation of the esophagus. Although one mesothelioma patient had recurrent fluid build-up after surgery, none of them had any toxic effects to their lungs.

Richardson and Mehta conclude that a mesothelioma therapy combining an accelerated course of high dose radiation with surgery is “innovative and promising” but that clinicians should proceed with caution and track their data carefully. “This will improve the safe delivery of large doses for these patients,” they write.

The findings will be presented in July at the 57th Annual Meeting and Exhibition of the American Association of Physicists in Medicine in California.


Richardson, S and Mehta, V, “Use of quality metrics for a new hypo-fractionated pre-surgical mesothelioma protocol”, June 2015, Medical Physics

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